FOR PROVIDERS
Refer A Patient
Online Application
Written Application and Authorization Forms
DME MAC DMEPOS
For any DMEPOS item to be covered by Medicare, the patient's medical record must contain sufficient information about the patient's medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). Insurance guidelines require original and/or appended documentation from the referring physician. According to updated Medicare guidelines, letters submitted separate from the physician face-to-face visit documentation are no longer accepted.
Please ensure the documentation submitted is a physician face-to-face visit within 90 days of order and includes the following information, as applicable:
1). Diagnosis and duration
2). Characteristics of tremor and/or abnormal movement pattern noted
3). Side(s) affected
4). Severity
5). List of functional deficits, nature and extent
6). Prognosis
7). Other therapeutic interventions and results
8). Justification for CUSTOM fabrication vs prefab- (i.e. only available in custom to meet the individual's unique needs regarding size, fit, respect for bony prominences, and undesirable involuntary movement patterns observed).
Please also include any of following as applicable:
Please ensure the documentation submitted is a physician face-to-face visit within 90 days of order and includes the following information, as applicable:
1). Diagnosis and duration
2). Characteristics of tremor and/or abnormal movement pattern noted
3). Side(s) affected
4). Severity
5). List of functional deficits, nature and extent
6). Prognosis
7). Other therapeutic interventions and results
8). Justification for CUSTOM fabrication vs prefab- (i.e. only available in custom to meet the individual's unique needs regarding size, fit, respect for bony prominences, and undesirable involuntary movement patterns observed).
Please also include any of following as applicable:
- Need for custom joint support due to at least ONE of the following: tremor causing hand and arm weakness, joint deformity, pain, stiffness, rigidity, tenosynovitis, abnormal tone, and/or joint contracture risk
- Need for proper anatomical positioning on involved side due to at least ONE of the following: presence of repetitive overexertion/strain due to tremors, history or risk for joint disease including OA, improper grasp utilized, excessive wrist extension while holding and manipulating objects, excessive shoulder elevation and/or adduction by side, and/or requires solid surfaces for support resulting in poor posture
- Patient responds favorably to manual sensory trick inhibition cue, geste antagoniste placed over involuntary contracting musculature in clinic. The custom orthoses components of the Readi-Steadi® system are based on the same proven neurological principle therefore, the referred patient would be a good candidate.
